Expert Wall: statements on FCTC and tobacco harm reduction (2025)

This page provides statements from independent experts on tobacco science and policy. They are addressed to delegates in advance of the 11th Session of the FCTC Conference of the Parties (COP-11), held in Geneva, 17-22nd November 2025. Each statement is linked from the author’s entry in the table of contents.

Disclaimer: Each statement represents the individual and independently expressed views of each contributor. Their inclusion here does not necessarily imply contributors’ support for other positions expressed on The Counterfactual website or elsewhere on this wall.

David Nutt, DM, FRCP, FRCPsych, FBPhS, FMedSci, DLaws

Edmond J Safra Chair and Director
Centre for Neuropsychopharmacology
Division of Brain Sciences
Department of Medicine
Imperial College, London
United Kingdom

Smoking causes a massive burden of death and disease worldwide, killing about eight million people annually and so on a similar scale to the COVID pandemic so far. But we now have vaping and other smoke-free alternatives to cigarettes that can dramatically cut the risks for people who cannot or do not want to quit using nicotine. There is no real scientific doubt that these smoke-free products are much safer than smoking and that they can help smokers quit. So we should be working hard to make that happen.

And yet the World Health Organisation has dug in against vaping and the other alternatives and is throwing every possible obstacle in the way. WHO continues to insist that smokers should just stop, even though we know millions of smokers simply will not do that and millions will continue to take up the habit. There are no other areas of public health where just demanding abstinence or trying to enforce abstinence via prohibition is seen as a credible strategy, but that is exactly what WHO is advocating for nicotine. The idea of harm reduction is deeply embedded in drugs and sexual health policy, for example. But for nicotine, it seems WHO would rather adopt an ideological stance and fail than take a pragmatic approach and save lives.

We are calling on the WHO leadership to launch a comprehensive rethink. We need to see some sign that WHO is embracing innovation, not squandering the opportunity to make a real difference to the global burden of cancer, heart disease and crippling lung conditions

---

Ruth Bonita, PhD, MD (hon), ONZM

Professor Emerita, University of Auckland
Former Director, NCD Surveillance, WHO, Geneva
New Zealand

Integrating Harm Reduction to Accelerate a Smokefree Future

Helping people who smoke move from burnt tobacco to far less harmful smoke-free alternatives is essential to ending the global smoking epidemic. Independent evidence, including real-world evidence from New Zealand, shows that regulated, reduced-harm smoke-free nicotine products can accelerate declines in smoking and prevent disease. Opposition to tobacco harm reduction is often framed as resistance to industry influence, yet the unintended consequence is to protect the cigarette market and slow progress in reducing the harm of tobacco. Recognising and proportionately regulating smoke-free nicotine products would strengthen—not weaken—the FCTC, align policy with science, and advance health equity. To reject harm reduction is, in effect, to preserve the dominance of the most lethal product—burnt tobacco.

---

Neal L. Benowitz, MD

Professor of Medicine Emeritus
University of California San Francisco
Zuckerberg San Francisco General Hospital
United States

My perspective as a cardiologist is that cigarette smoking, due to inhalation of products of combustion, is the most important threat to cardiovascular health. Cigarette smoke produces extreme levels of oxidant stress, causing inflammation, endothelial dysfunction and thrombogenesis, all of which contribute to atherosclerosis and acute cardiovascular events.  The absolute priority of medicine should be to eliminate the use of combusted tobacco products.

My perspective as a clinical pharmacologist and a career-long nicotine researcher is that nicotine has some potential adverse effects, but far fewer and less severe than combusted tobacco. The strongest evidence for the relative safety of nicotine is the Scandinavian experience with smokeless tobacco, where nicotine exposure is similar to that from cigarette smoking but without inhalation of combusted tobacco. Numerous epidemiology studies show that the prevalence of adverse health effects of smokeless tobacco use in Scandinavia is quite low.

The major concern with nicotine use is addiction, particularly among adolescents. This obviously requires regulatory attention. On the other hand, non-combusted nicotine products can play an important role in promoting smoking cessation, including in the circumstance in which reduced nicotine standards for cigarettes are implemented.  Nicotine has other beneficial effects, including enhancing attention in people with attention deficit problems and other neurocognitive problems. Adults may rationally choose to accept the relatively low risks of non-combusted nicotine products to achieve its beneficial effects.

The focus of the FCTC should be to promote the elimination of cigarettes and other smoking products.  Regulation of nicotine per se is a far less compelling goal and should not distract from efforts to end smoking.

---

Ann McNeill, PhD

Professor of Tobacco Addiction
Addictions Department,
Institute of Psychiatry, Psychology & Neuroscience,
King’s College London,
London, United Kingdom

If we really want to end death and disease caused by the use of nicotine, then we all need to come together. The World Health Organisation (WHO) has the power to do this. As someone who has worked with WHO and who was a past Chair of the then WHO Scientific Advisory Committee on Tobacco Product Regulation, I believe that WHO’s own values charter sets out how to do this. I give some examples below.

Value 1 – ‘Trusted to serve public health at all times’. This includes that ‘Our actions and recommendations are independent’. WHO needs to demonstrate that it is acting independently of any vested interests, including philanthropic funders and the nicotine industry.

Value 2 – ‘Professionals committed to excellence in health’. This includes ‘We are guided by the best available science, evidence and technical advice’. WHO recognised that tobacco smoking was a uniquely deadly form of nicotine delivery when it classified nicotine replacement therapies as essential medicines in 2009. Evidence of the role of other non-combustible nicotine delivery devices in reducing death and disease cannot, therefore, be dismissed as a tobacco industry ploy. WHO, therefore, urgently needs to convene scientists representing different interpretations of this evidence, from diverse disciplines and countries, to discuss it openly and transparently, facilitated by truly independent chairs. Discussions should include the absolute and relative harms of different nicotine products, individual and population impacts, optimal regulatory frameworks and industry exploitation.

Value 3 – ‘Persons of integrity’. This includes ‘We practice the advice we give to the world’. Obviously, this cuts across all health areas and is a high standard to keep. But in this field, it means everyone involved with WHO should be saying to the world what it would say to one’s mother, son or friend if they smoked, or used other nicotine products.

Value 4 – ‘Collaborative colleagues and partners’. This includes ‘We communicate openly with everyone and learn from one another’. WHO must therefore be open to different interpretations of the evidence and not tolerate people who express different interpretations being maligned as using the tobacco industry playbook. In WHO’s own words, it should ‘use the power of diversity to achieve more together’.

Value 5 – ‘People caring about people’.  This is probably the most important value in relation to nicotine use and includes ‘We courageously and selflessly defend everyone’s right to health’.  The Special Rapporteur’s paper on harm reduction for sustainable peace and development (A/79/177) rightly put the spotlight on ‘populations that are often stigmatized, criminalized and discriminated against to the detriment of their enjoyment of human rights’.  Sadly, this is currently happening to people who use nicotine (and disproportionately vulnerable people) in many countries of the world. The Special Rapporteur, however, fell short of applying the spotlight to people using nicotine, because of the role of the tobacco industry. In my view, WHO needs to adhere to its core value and take a compassionate and inclusive approach, and discussions should also include people with lived and living experience of nicotine use across a diversity of backgrounds, ages, countries and experiences.

In summary, by faithfully honouring its core values, I believe WHO can restore trust and bring different communities together. It can ensure that people who use nicotine are encouraged, as with all other drugs, including alcohol, to become drug-free, whilst also communicating the unique harms from combustible tobacco products so that such products rapidly become obsolete.

---

K. Michael Cummings, PhD, MPH

Professor,
Medical University of South Carolina
United States

The WHO has a blind spot when it comes to accepting the scientific evidence of differential health risks between smoked and non-smoked tobacco products.  Unfortunately, WHO’s ideologic position that smoking harm reduction is an industry ploy ignores the scientific evidence that lower risk nicotine products can save lives and accelerate a reduction in smoking worldwide.  Evidence from Sweden, and more recently countries such as New Zealand, the United States and England demonstrate that a free-market approach where consumers can have access to lower risk nicotine tobacco products can speed up reductions in cigarette use and accelerated improvements in population health. 

---

Caitlin Notley, PhD

Director, Public Health Research Department,
University of East Anglia
Editor-in-Chief, Nicotine & Tobacco research
United Kingdom

To improve health, prevent disease and reduce early death, it is essential to support people, especially in disadvantaged populations, to stop smoking. If we aim to achieve maximum health benefits, the goal of the ‘tobacco endgame’ should be to achieve a smoke-free society. Many people struggle to quit smoking and need support. ‘Harm reduction’, i.e. substituting nicotine in harmful tobacco for cleaner forms of nicotine delivery, so that people can switch away from smoking without experiencing withdrawal, is an important form of support for people who struggle to quit. If the endgame aimed to eradicate nicotine use, not only would it be likely to fail, but we would cut off a vital form of support for many people who smoke, causing excess preventable death and disease.

---

Kenneth Warner, PhD

Avedis Donabedian Distinguished University Professor Emeritus of Public Health,
Dean Emeritus of Public Health
University of Michigan
United States

Evidence from six completely different sources demonstrates that vaping is increasing smoking cessation.

1. Randomized controlled trials. The Cochrane Review, the gold standard of scientific credibility, says there is “high certainty evidence” that vaping increases smoking cessation more effectively than do nicotine replacement therapy products.
2. Population studies find e-cigarettes increasing smoking cessation, especially when people use e-cigarettes frequently.
3. As e-cigarette sales rise, cigarette sales fall. Econometric studies confirm the two products are substitutes.
4. Other studies have found that policies intended to decrease youth vaping have increased youth smoking. Another study found that a tax on e-cigarettes in Minnesota increased adult smoking and decreased smoking cessation.
5. Multiple simulation analyses have concluded that the potential benefit of vaping for adult smoking cessation substantially outweighs any risk that vaping might increase youth smoking.
6. Swedish men’s substituting snus, a smokeless tobacco product, for cigarettes demonstrates the potential for lower-risk products to dramatically reduce tobacco-produced diseases.

Tragically, public health organizations that focus exclusively on the potential risks of vaping for young people – risks that, frankly, have been grossly exaggerated – are likely to be damaging the health of the public.

---

Andrzej M. Fal, MD, PhD, MBA, FAAAAI

Prof. of Medicine
President, Polish Society of Public Health
Cardinal Stefan Wyszyński University in Warsaw
Faculty of Medicine. Collegium Medicum
Poland

The division between purists and pragmatists in the fight against cigarette smoking is intensifying. The WHO is firmly pushing a purist line: aiming at an endgame for all nicotine use. As a pragmatist and practitioner, I believe we should prioritise reducing disease and death, and that means we should focus on reducing smoking in any way we can. The problem with nicotine-free purism is that it will distract from the real public health goal of reducing smoking and disease and ultimately do more harm than good.

Despite decades of standard tobacco control measures, around one quarter of European adults still smoke. However, pragmatic countries that significantly improve their situation and reduce the number of cigarette smokers are those that introduce extensive regulations, support fiscal policies, and social bans with the availability of alternatives for quitters. At the same time, they educate the younger generation about the harmful effects of both smoke and nicotine. This two-pronged approach leads more quickly to the goal of a smoke-free Europe/world. Unfortunately, we largely ignore the experiences of Sweden, New Zealand, and England, and most countries are as far from achieving the goal as they were 10 years ago. The current WHO strategy has ceased to be effective, and its further tightening in real life has resulted in the stabilization of the number of smokers in most countries that adhere to it orthodoxly. And every year we pretend to be successful when we are actually standing still means another 8 million deaths worldwide.

John Britton, MD

Emeritus Professor of Epidemiology
School of Medicine
Nottingham University
United Kingdom

Health policy should be driven by science, not prejudice or dogma. Vaping has already provided an effective gateway out of smoking for millions of people, unequivocally benefitting individual smokers, public health and wider society. It beggars belief that the WHO appears to be incapable of understanding the basic science, or designing rational policy to capitalise upon, rather than reject, the opportunities that harm reduction offers. By seeking to block access to less hazardous nicotine products, other than licensed medicines, the WHO is adding and abetting the tobacco industry to kill millions of people.

---

Peter Hajek, PhD

Professor of Clinical Psychology
Director of the Health and Lifestyle Research Unit
Wolfson Institute of Preventive Medicine
Queen Mary University of London
United Kingdom

When smokers switch to vaping or nicotine pouches, their intake of toxicants responsible for the main health risks of smoking is almost entirely removed. Yet, in a stark contrast to its mission to promote health, the WHO has been discouraging smokers from making the switch and urging regulators to prevent it. Despite the WHO’s efforts, low-risk alternatives to smoking will eventually eradicate smoking-related disease and death, but the process will take much longer than it would if the WHO was supporting it, rather than trying to stop it. Future historians will marvel at how the World Health Organisation could have strived for years to actively undermine the goals of public health.

---

Jean-François Etter, PhD

Honorary professor
Faculty of Medicine
University of Geneva
Switzerland

The only solution: change the leadership of the WHO and the FCTC Secretariat

The mission of the WHO, COP-11 and the FCTC Secretariat is to reduce tobacco-related morbidity and mortality, which are almost entirely caused by combustible products. Their recommendations and policies should be based on sound scientific evidence. However, instead of pursuing this noble mission, they have launched an ideological campaign against non-combustible tobacco and nicotine products, despite numerous scientists informing them that this approach is counterproductive and undermines their mission. Appeals to reason are no longer sufficient and will not bring about the necessary changes. A complete overhaul is required. With the help of the citizens most affected by this situation (e.g., smokers who are denied access to safer alternatives to cigarettes) and a wide range of stakeholders, WHO Member States should replace the entire leadership responsible for tobacco control policy at the WHO and replace the heads of the FCTC Secretariat. In their place, they should appoint individuals who are willing to implement science-based, ideology-free policies. There is no other solution to a political situation that is currently causing death and disease and must end as soon as possible.

---

Robert West PhD

Professor Emeritus of Health Psychology
University College London
United Kingdom

The goal of reducing the toll of death and disease caused by tobacco requires policies that accurately reflect the epidemiological evidence on the harms of different types of tobacco and nicotine products. Overall harm is a function of the number of users of different products, the pattern of use of these products and the harm per person associated with that pattern of use. It is vital for policymakers in individual countries and international organisations to direct their policies to addressing this ‘harm equation’. Black-and-white thinking that fails to do this leads to policies that harm public health, leading to avoidable death and disability caused by tobacco. Moreover, all public bodies have a profound responsibility to represent epidemiological evidence accurately and convey that information accurately to the public. Conveying the impression that all tobacco and nicotine products have broadly similar levels of harm from typical patterns of use runs counter to this principle.

---

Tikki Pang, PhD

Professor
Senior Consultant,
Centre for Healthcare Policy & Reform Studies (CHAPTERS),  
Jakarta, Indonesia

The conflation of arguments between a hypothetical risk to youth and the benefits for adults who want to quit the deadly habit of smoking remains a major barrier to the wider acceptance of safer alternative tobacco products globally

---

Bernhard-Michael Mayer, PhD

Professor of Pharmacology and Toxicology
University of Graz
Austria

Common sense — and every child’s intuition — tells us that inhaling vapor from a heated liquid is far less harmful than inhaling smoke from burning plant material. Fortunately, we do not have to rely on common sense alone. All available emission studies consistently show a substantial reduction in toxic compounds from e-cigarettes compared to combustible cigarettes. There is broad scientific agreement that nicotine itself is not responsible for the severe diseases caused by smoking. Nevertheless, the World Health Organization (WHO) has shifted from a justified war against tobacco smoke to an unjustified war against nicotine — a relatively benign substance that many consumers use for its positive effects on mood and cognition.
Clinical research has demonstrated that the cancer risk associated with vaping is lower by several orders of magnitude and that smokers’ lung function begins to improve within weeks of switching to vaping. Given the WHO’s longstanding commitment to reducing the global burden of smoking-related disease, its current opposition to vaping is difficult to reconcile. By maintaining a negative stance toward lower-risk nicotine products, the WHO’s current tobacco control policy risks missing a historic opportunity to accelerate the decline in smoking rates and save millions of lives worldwide.

---

Dr Alex Wodak AM

Emeritus Consultant, Alcohol and Drug Service, St Vincent’s Hospital, Sydney 
Tobacco Harm Reduction Adviser to the Harm Reduction Australia Board
Australia

Access Dr Wodak’s extended statement here.

I wish to address a number of pernicious myths that have emerged in tobacco science and policy and routinely arise in the COP.

• “There is no apparent difference in risks between smoked and smoke-free products (or at least considerable doubt about this difference)”
  This claim now fails on several grounds. First, two out of every three long-term smokers die from a smoking-related condition. But with over 100 million vapers present in virtually every country in the world now, and vaping existing for at least 15 years, there have been no scientifically attributed deaths from vaping nicotine anywhere in the world. Second, with approximately 7000 high-concentration toxicants in cigarette smoke, including 70 carcinogens and carbon monoxide and less than 200 low-concentration toxicants in vaping aerosol, there is a high probability that vaping is much less dangerous than smoking. Third, smoking-related symptoms decrease after smokers have switched completely from cigarettes to vaping nicotine. 
• “The problem is nicotine and addiction – we need a nicotine-free society”
  The aim of health policy should be to improve the quantity and quality of human life, that is, to reduce death and disease. If people can still continue to ingest nicotine but have a much lower risk of death or disease, even if dependent on nicotine, this should be regarded positively.
• “Harm reduction is a tobacco industry marketing ploy”
  The first vaping device that was commercially successful was developed by a smoker who had struggled unsuccessfully to quit smoking for many years. The tobacco industry was slow to catch on to the importance of vaping. Even if the tobacco industry were to exploit harm reduction, why would this matter? Harm reduction is an effective public health strategy explicitly endorsed by the Framework Convention on Tobacco Control, along with supply reduction and demand reduction. 
• “Young people are the critical population, and prevention justifies heavy regulation”
  Middle-aged and older smokers are at the highest risk of developing or dying from a smoking-related condition. Countries with the highest rates of use of smoke-free nicotine options have the lowest rates of smoking among young people. 
• “Prohibition of vapes is the preferred policy”
  When demand for a good or service is strong, supply is difficult or impossible to interrupt, and the replacement good or service is less risky than the prohibited good or service, then prohibition is certain to fail and to carry severe unintended negative consequences. Demand for nicotine vapes and other forms of tobacco harm reduction is very strong and growing. Law enforcement is unable to significantly disrupt the supply, and attempts to do so result in severe unintended negative consequences.

---

Sharifa Ezat Wan Puteh, MD, MPH, PhD

President Malaysian Society of Harm Reduction
Public Health Physician
Faculty of Medicine, National University of Malaysia
Malaysia

Understanding Strategies to Minimise the Health Impact of Tobacco Use

Tobacco harm reduction is a public health strategy aimed at lowering the adverse health effects associated with tobacco use. Instead of focusing solely on cessation, harm reduction acknowledges that some individuals may continue using tobacco products and seeks to offer alternatives or interventions that reduce the risks involved. Abstinence is always the goal, its just how smokers achieve it. It may be a long winded process with reduced risk exposure tiering and higher compliance than traditional NRTs. Harm reduction is based on the principle of meeting individuals where they are, respecting personal choices, and reducing health risks even when complete abstinence is not achieved. In the context of tobacco, this involves providing safer alternatives and encouraging practices that decrease exposure to the most dangerous elements of tobacco consumption. Policies must also try to reduce any nicotine initiation, among the younger people, as not to start nicotine addiction.

Examples of Tobacco Harm Reduction Strategies

• Switching to Smokeless Tobacco: Products such as snus and chewing tobacco do not involve combustion and generally present lower health risks than smoking, though they are not totally risk-free.
• Nicotine Replacement Therapy (NRT): NRTs such as patches, gum, lozenges, and inhalers deliver nicotine without the harmful byproducts of burning tobacco, helping individuals manage cravings while reducing exposure to toxins.
• The Use of Electronic Cigarettes (E-cigarettes): E-cigarettes heat a liquid containing nicotine to create an aerosol. While not completely safe, studies suggest that they are significantly less harmful than traditional cigarettes.
• Reducing Cigarette Consumption: Even if individuals do not quit entirely, reducing the number of cigarettes smoked daily can decrease health risks. This might happen in people who dual use and in the transition of switching.
• Education and Support: Providing information about the relative risks of various products and supporting individuals in making informed choices is an essential component of harm reduction.

Controversies and Considerations

Tobacco harm reduction is not without controversy. Some public health experts worry that promoting alternative products could normalize tobacco use or attract new users, especially among youth. However, proponents argue that for existing smokers who are unable or unwilling to quit, providing safer options can save lives and reduce healthcare burdens. Tobacco harm reduction recognises the complexities of addiction and the challenges many individuals face in quitting tobacco. By offering practical, evidence-based alternatives and support, harm reduction strategies aim to minimise the health impact of tobacco use on individuals and society, while continuing to encourage cessation as the optimal goal.

---

Thomas J. Glynn, PhD

Adjunct Lecturer
Prevention Research Center
School of Medicine
Stanford University
United States

The actor Yul Brynner, who died from a smoking-related lung cancer, recorded a message to be distributed by the American Cancer Society immediately after his death in 1986. It was both a stark and a direct message: “Now that I’m gone, I tell you – Don’t Smoke, Just Don’t Smoke”.

That is the message – both science-based and heart-wrenching – that should guide the deliberations at COP 11, i.e. it is cigarette smoking that causes, by far, the majority of the death and disability from tobacco use. The eventual elimination of cigarette smoking was the focus of the negotiations 25 years ago that led to the FCTC and should be the focus of the negotiations at COP 11. 

Of course, there is a continuum of risk among tobacco and nicotine products, but it is cigarette smoking that killed and disabled nearly all tobacco and nicotine users in 2000 and continues to do so today, 25 years later. We should not – cannot – continue to let the current tobacco harm reduction debate split the once-united tobacco control community. We need to re-unite by following the science and focus on the reduction and eventual elimination of cigarette smoking. THAT should be the focus of COP11.”

---

Jacques Le Houezec, PhD

Neuroscientist and Smoking cessation specialist
Manager Amzer Glas – CIMVAPE, training and certification organisation,  Plobannalec-Lesconil
France

Smoking kills because combustion kills (as well as misinformation). Non-combustible forms of nicotine (snus, NRT and vaping products) have helped millions of smokers to stop smoking worldwide. As a smoking cessation specialist in France, I have helped hundreds of smokers to stop smoking with NRT and vaping products. Denying smokers to use non-combustible forms of nicotine of any sort by demonizing or banning them is against human rights to choose their way out of smoking.

---

Sharon Cox, PhD

Principal Research Fellow
University College London
United Kingdom

The guiding principles of harm reduction are to respect the rights of people who use substances, to reduce stigma, to work with the networks that support people who use substances and to follow the scientific evidence. There is strong evidence that tobacco harm reduction can achieve these goals, but we need all major health organisations to support this vision – and that includes WHO. Denial or selective interpretation of the evidence, including deliberate conflation of nicotine and tobacco, means those individuals facing severe disadvantage will continue to be left behind and continually stigmatised, and tobacco health inequalities will remain entrenched. If the WHO engaged with the evidence for tobacco harm reduction with genuine objectivity and dispassion, we could all work together to accelerate progress on reducing major diseases and health inequalities, leaving no smoker behind.

---

Karl E Lund, PhD

Senior Researcher
Norwegian Institute of Public Health
Norway

Closing the life-saving escape route that smokers can have in nicotine pouches, snus and e-cigarettes is a bit like closing the door to the fire escape because the steps may be slippery.

---

Kiran Melkote, MBBS, MS (Orthopaedics)

Director
Association for Harm Reduction Education and Research (AHRER)
India

Tobacco Control cannot ignore Bioethics

The FCTC’s ‘abstinence-only’ dogma violates all four core principles of bioethics.

It violates Autonomy by denying adults who smoke the right to make informed choices about their own health and bodily integrity.

It violates Non-maleficence (do no harm) by actively blocking access to life-saving, smoke-free alternatives, thereby perpetuating the far greater harm from combustible tobacco.

It violates Beneficence (do good) by rejecting proven harm reduction strategies that could save millions of lives.

And it violates Justice by imposing a one-size-fits-all policy that disproportionately harms the most vulnerable populations—those with the highest smoking rates and fewest resources—by denying them accessible and effective alternatives.

Protecting youth is essential, but it cannot be a pretext to abandon our ethical duties to adults. When policy denies a person who smokes a viable escape from cigarettes, it is not public health; it is state-enforced harm.

---

Ethan A. Nadelmann

Founder & Former Executive Director (2000-2017)
Drug Policy Alliance
New York and International

It took WHO all too many years to embrace “harm reduction” thinking and policies vis a vis consumers of illicit drugs but it eventually did. Hundreds of thousands, possibly millions of lives, could have been saved if WHO had acted earlier to transcend the political forces and counterproductive ideologies and rhetoric that drove the war on drugs and its insistence on punitive abstinence-only policies.

Yet now we see WHO repeating very similar mistakes as it resists and dismisses the technological innovations in tobacco and nicotine products that could radically reduce associated harms to both consumers and society at large. The organization’s leaders need to open their eyes and summon the courage to follow the science, not the politics. Failure to do so may ultimately result in the emergence of an international tobacco/nicotine prohibition regime with all the failures, costs and counter-productive consequences of the failed global drug prohibition regime.

---

Lion Shahab, PhD, FRSNT, FBPsS

Professor of Health Psychology
University College London
United Kingdom

Long-term smoking cessation is notoriously difficult to achieve, and tobacco use results in millions of avoidable deaths each year. The aim of tobacco control should be to reduce tobacco-related preventable morbidity and mortality. To achieve this goal, as the WHO statement says, “we must be guided by science and evidence”. It is therefore disappointing to see that this WHO statement makes questionable and anti-scientific claims about the role that e-cigarettes can play in helping smokers to quit and live longer.

There is now substantial evidence, both from clinical trials and real-world studies, that e-cigarettes are as effective as other proven cessation medications and have helped millions of smokers, who have struggled to stop with other means, to quit cigarettes for good. While not harmless, numerous studies have shown that compared with cigarettes e-cigarettes significantly reduce exposure to toxic and carcinogenic compounds that cause the majority of smoking-related illnesses. This will reduce the death toll if smokers switch over to e-cigarettes completely. We should provide smokers with all available support to achieve a smokeless society, much of which is detailed by the WHO statement, but based on the latest science and best evidence, this should also include e-cigarettes.

---

Martin Jarvis, OBE, PhD

Emeritus Professor of Health Psychology
University College London
United Kingdom

It is the smoke from cigarettes that kills, not the nicotine. The starting point for rational regulation of tobacco has to be to an appreciation of the risks: favour non-combustibles and bear down on cigarettes and other combustibles. It’s a no-brainer.

---

Michael Kunze, MD

Professor Emeritus of Public Health
Center for Public Health
Medical University of Vienna
Austria

Tobacco control has focused on reducing use, with little emphasis on regulating product toxicity. Articles 9 and 10 of the World Health Organization’s Framework Convention on Tobacco Control (FCTC) offer a mechanism to reduce harm by limiting toxic emissions, but implementation has stalled. A science-based regulatory framework is needed to set emission thresholds for toxicants. Inspiration can be found from other regulated sectors, and the initial focus should be on nine priority toxicants strongly linked to tobacco-related disease. An adaptive, evidence-based approach can complement existing strategies and accelerate harm reduction for more than 1 billion people who still smoke. The 11th FCTC Conference of the Parties in 2025 presents an opportunity to revisit the development of a toxicity reduction strategy.

---

Clifford E. Douglas, J.D.

Adjunct Professor, Department of Health Management and Policy
University of Michigan School of Public Health
United States

Health policy should be driven by science, not bias, dogma, or lack of understanding. Vaping has already provided an effective gateway out of smoking for millions of people, unequivocally benefitting individual smokers, public health and wider society. Other alternative forms of nicotine delivery are also playing growing roles in supporting both individual and public health. Thus, it is somewhat extraordinary that the WHO appears to be incapable of understanding the basic science, or designing rational policy to capitalise upon, rather than reject, the opportunities that harm reduction offers. By seeking to block access to less hazardous nicotine products, other than licensed medicines, while simultaneously misinforming the public and health care providers about relative risk and the actual nature and impact of nicotine, the WHO is effectively ensuring the premature deaths of millions of people around the world whose lives otherwise could have been saved.

---

Ron Borland, PhD

Professor of Health Behaviour
Faculty of Health/School of Psychology
Deakin University
Australia

The roles and implications of black markets are often ignored by governments ​when setting policies ​f​or behaviours they seek to discourage.  We are learning how disastrous this can be from the example of Australia and other countries.  Almost certainly due to Australia’s high taxes, there is now a thriving black market for cigarettes, with estimates now suggesting between a third and two-thirds of this market is now illicit. What are the implications? For tobacco control, it means that the effective price of cigarettes is now being set in the black market, and is now less than half the price of those legally bought cigarettes, packs lack health warnings and come in fully branded packs, and while it seems likely the total market is shrinking, tobacco and nicotine users are being increasingly exposed to criminal activity. Young people are the most vulnerable to these malign influences. Those using the black market can also obtain many items banned in the legal market, rendering the bans notional.  

From a broader societal viewpoint, it represents a fundamental failure of basic societal mechanisms. It is helping crime grow, and the money they make is likely feeding back to other forms of crime, opening up increased risks of official corruption and threatening community trust in governments.  In the case of nicotine, this is being exacerbated by the systematically distorted claims about its harms, especially relative to smoking. In a world where trust in governments is under increasing threat, taking a position on vaping and other toxin-reduced nicotine products that is at odds with the views of significant sectors of the relevant scientific community feeds into this distrust.  If you lie to us about vaping, then how can we believe you about the benefits of vaccination or the need to take action around climate change?  Turning to what the magnitude of the black market says about nicotine use, it is clear that many smokers want to avoid the harms from smoking, but want to continue to use nicotine recreationally.  Despite 20 years of the FCTC​, progress in reducing smoking has been slow, except in countries which have embraced low-toxin alternative forms of nicotine, where progress has been more rapid.  There is no good evidence to suggest that we can successfully eliminate nicotine use​. ​However, there is a chance we might be able to eliminate smoking via substitution to lower​-toxin nicotine in those unwilling or unable to quit nicotine.  We need to live with low-toxin nicotine and regulate it to minimize youth use and to prevent aggressive marketing.  But such control can only work if the black markets are minimised.

---

James Martin, PhD, SFHEA

Senior Lecturer
Criminology Course Director
School of Humanities and Social Sciences
Deakin University
Melbourne
Australia

The current WHO position on nicotine regulation – including calls to continually increase the price of tobacco and implement bans on consumer access to vapes – increasingly resembles a new front in the War on Drugs. Just like the conventional drug war, these policies are unenforceable in practice and ultimately work to the benefit of organised crime groups. 

Australia is a leading case study of the dangers that accompany the implementation of neo-prohibitionist nicotine policies. Following a series of extraordinary tax increases 

on tobacco and a ban on consumer vapes, the black market for these products has exploded. Nicotine is now the 2^nd most popular illicit drug in the country, exceeding the combined value of the MDMA, cocaine, heroin and cannabis markets. 

The ongoing battle between organised crime groups for control of the illicit nicotine market has resulted in unprecedented systemic violence, including hundreds of arson attacks, multiple homicides, and countless instances of robbery, assault, and extortion. 

Despite huge increases in law enforcement funding, expanded police powers, and ever-growing arrests and seizures, there is no sign that the growth of the black market has slowed. Indeed, there are early indicators that Australia is experiencing its first increase in smoking in several decades due to the widespread proliferation of cheap illicit tobacco. 

These outcomes show that when consumers do not have sufficient legal access to affordable, and preferably less harmful, forms of nicotine, illegal suppliers inevitably step in to meet this demand. This threatens not just public health but also public safety, and, just like the conventional War on Drugs, will almost certainly end in failure.

---

David Sweanor, JD

Adjunct Professor of Law
Chair of the Advisory Board of the Centre for Health Law, Policy and Ethics
University of Ottawa
Canada

Effective public health efforts need to be based on science, reason and humanism. Yet the world’s premier health body is aligning itself against all three when dealing with nicotine. The result is that one of the greatest opportunities to improve global health, separating nicotine use from smoke inhalation, is being squandered.  Global trust in health authorities, and the WHO in particular, has never been so important. Yet the WHO is abandoning science, rationality and humanism on nicotine and instead apparently pursuing the moralistic abstinence-only agenda of external funders. This is a public health tragedy that extends well beyond the unnecessary sickening of the billion-plus people who smoke cigarettes.

---

Jonathan Foulds, PhD

Professor of Public Health Sciences & Psychiatry
Penn State University, College of Medicine
United States

Nicotine is not the ingredient in tobacco products that causes cancer or respiratory diseases. But it is the drug that people smoke, chew and inhale aerosols for. Unfortunately, most young people and most tobacco product users are unaware that some forms of nicotine are much less harmful than smoking.  They have been misinformed not only by the tobacco industry but by the public health professionals. There is now certain evidence that nicotine products like electronic cigarettes and nicotine pouches deliver far fewer toxic chemicals than smoked tobacco. Let’s correct the misinformation and educate smokers about the continuum of risk, and that switching to products like electronic cigarettes can help them to quit smoking.

---

Eva Králíková, MD, PhD

Institute of Hygiene and Epidemiology, First Faculty of Medicine,
Centre for Tobacco-Dependence of the 3rd Department of Medicine – Department of Endocrinology and Metabolism, First Faculty of Medicine,
Charles University, Prague and the General University Hospital in Prague
Czech Republic

I had an amazing experience when I was involved in the formation of the FCTC in the early 2000s. During each meeting, we prepared materials for the delegates, and it was fantastic to see how we could draft such an important document, endorsed by representatives from almost every country. We based our work strictly on recommendations derived from evidence-based medicine. If the FCTC were properly implemented, it would save more lives than many medical interventions, and the then WHO Director-General, Gro Harlem Brundtland, deserved the Nobel Prize in Medicine for this.

In the definitions used in the FCTC (2003), harm reduction is listed as one of the three pillars of tobacco control. To this day, other publications support this: in countries where vaping is widely available, the prevalence of smoking is declining more rapidly. Given that vaping has been widespread for more than 15 years, it has been proven that the level of toxic substances inhaled through vaping is not zero, but only a few per cent compared to smoking. We should therefore focus primarily on the availability of traditional cigarettes: introduce standardized packaging, sell only in licensed stores (not with food), systematically increase taxation, and guarantee a smoke-free environment. Although vaping is certainly not harmless, the public should be aware of the level of risk compared to smoking, and smokers should be given the opportunity to use vaping to help them quit cigarettes. At the same time, no form of nicotine should be marketed to non-smokers, including children.

---

David B Abrams, PhD

Professor of Social and Behavioral Sciences
New York University School of Global Public Health
United States

The FCTC Conference of the Parties should base its policies, decisions and recommendations on the strongest scientific evidence available. The WHO and FCTC can do better at saving the lives of over a billion smokers by updating the underpinning science and by correcting the lethal misinformation that all forms of nicotine and tobacco products are equally deadly. We must get beyond the idea that smokers should quit completely or die in agony, rather than dramatically reduce their health and welfare risks by using far less harmful modes of nicotine delivery.

We are now seeing governments embracing misinformation tantamount to propaganda. This is unacceptable from public institutions such as the WHO. It is antithetical to the core values of public service. To pursue social justice and advance the eradication of preventable chronic diseases, we need to understand that tobacco smoke, but not nicotine itself, is the primary driver of chronic diseases, death and untold suffering.

---

Jasjit S Ahluwalia, MD, MPH, MS

Professor, Behavioral and Social Sciences and Professor, Medicine
Center for Alcohol and Addiction Studies
Brown University School of Public Health and Alpert School of Medicine
Deputy Director CADRE, a NIH funded Center of Excellence (COBRE)
United States

I am an Internal Medicine Physician, and we accept harm reduction as a viable concept, whether we are treating hypertension, diabetes, opiate addiction, or even tobacco use. I have taken care of thousands of patients, many of whom smoked, and they either never quit smoking cigarettes, or were only able to quit after multiple attempts.

We need more prescription smoking cessation products to come to market, as it has been almost 20 years since Varenicline was approved in the United States. But we also need to explore other options. We have to accept that many smokers do not want to quit, or have tried many, if not all, smoking cessation medications. Not only should we support their use of alternative nicotine products, we should encourage it. This includes e-cigarettes and nicotine pouches.

I have been doing clinical trials for over 30 years using every smoking cessation product. I published the first pod-based 4th generation e-cigarette clinical trial, and the first nicotine pouch clinical trial done outside of the tobacco industry. Our findings are robust and impressive. Smokers who do not want to quit, or have trouble quitting, should have the right and option to use an e-cigarette and/or a nicotine pouch.

---

Scott D. Ballin, JD

Health Policy Consultant
Former Vice President and Legislative Counsel, American Heart Association
Former Chairman of the Coalition on Smoking OR Health (AHA, ASCS. ALA)
United States

There are about one billion smokers worldwide, 80% in low- and middle-income countries. Each year, around seven million people die from smoking, making it the leading preventable cause of disease and death. Preventing non-communicable diseases (NCDs)—including cancer, heart disease, diabetes, and lung disease—remains a top global health priority.

After decades working to reduce tobacco-related harm, I remain frustrated by what can only be described as a “dark ages” approach to tobacco control. While traditional measures still have value, the WHO and other bodies have largely failed to recognize how regulation, science, innovation, consumer insight, and market competition could be used to provide the world’s billion smokers with viable, lower-risk alternatives—while still protecting youth from nicotine use.

The WHO’s MPOWER program, launched 17 years ago, was an important step but has not evolved alongside changes in the tobacco and nicotine landscape. A decade ago, I proposed modernizing it in “Is it Time to Upgrade and Redefine the MPOWER Program?” 

Meaningful progress also requires inclusive stakeholder engagement. Models such as the U.S. FDA, the Food and Drug Law Institute, and the University of Virginia’s Institute for Engagement and Negotiation (IEN) show how structured dialogue can build consensus. IEN’s 2024 Morven VII Report, “Accelerating Actions to Clear the Smoke: Finding Common Ground in a Polarized World,” outlines ten core principles that could guide the WHO and member nations toward a more balanced, evidence-based discussion of tobacco harm reduction.

---

Wayne Hall, PhD

Emeritus Professor
National Centre for Youth Substance Use Research
The University of Queensland
Australia

The World Health Organisation’s policies towards e-cigarettes (and other reduced risk nicotine and tobacco products) ignore the interests of smokers who wish to use them to quit smoking or as a substitute for smoking cigarettes. Instead, the WHO has used the goal of minimising youth uptake of these products to justify a de facto prohibition on access to e-cigarettes by smokers.

Australia has implemented the WHO’s preferred restrictive policy on e-cigarettes by only allowing their use on prescription. This policy has become a de facto form of prohibition in the absence of approved products to prescribe and in the face of strong medical resistance to prescribing e-cigarettes and oral tobacco products and pharmacists’ reluctance to stock these products.

Australia’s policy has not prevented youth uptake of e-cigarettes. It has only ensured that unregulated e-cigarettes are almost wholly supplied by the illicit market. Attempts to discourage youth uptake of e-cigarettes have also counterproductively convinced adult smokers that there is no difference in risk between smoking cigarettes and using e-cigarettes and that e-cigarettes are not effective in assisting smokers to quit.

A more balanced public health policy would allow smokers to access e-cigarette s in ways that minimise youth uptake and maximise the potential for e-cigarettes to eliminate the global use of combustible tobacco products. This would involve the sale of approved products as consumer goods to adults by licensed retail outlets that require proof of age at purchase and are only allowed to promote these products at point of sale.

---

Raymond Niaura, PhD

Professor of Social and Behavioral Sciences
New York University School of Global Public Health
United States

We can make a massive contribution to public health by shifting global nicotine use from its most deadly forms, like cigarettes, to far safer smoke-free forms, like vapes, pouches, smokeless and heated tobacco. Misinformation that conflates the risks of all forms of nicotine delivery egregiously deprives smokers, the public, and policymakers of responsible options and individual choice to reduce risk and avoid harm. It grossly ignores the full weight of current scientific evidence, evidence that can and should more rapidly make the most lethal combusted forms of smoked tobacco obsolete, avoid years of suffering and save millions and millions of lives much faster than could otherwise be achieved.  We cannot expect the FCTC to advance public health if delegates rely on poor analysis, flawed evidence, and activist talking points. 

---

Frank Baeyens, PhD

Professor of Psychology,
KU Leuven
Belgium

Over the past decade, as an academic researcher, I have thoroughly reviewed the thousands of scientific studies relevant to assessing the value of Tobacco Harm Reduction (THR) in general, and of the e-cigarette in particular, in the fight against smoking and its detrimental health effects. Also, my own research over the past decade has been devoted exclusively to various facets of THR.

If the e-cigarette is to be used as a THR tool, it is important to demonstrate (a) that  it is indeed a low-risk nicotine product, but also (b) that it is accepted by current smokers and effective in supporting smoking cessation, while (c) that it does not attract substantial numbers of non-smokers and, more importantly, does not cause smoking initiation in (young) people who would otherwise not start smoking.

Based on my analysis of the literature and on my own research, I conclude that vaping passes these three critical tests with flying colors.

(a) Even the strongest anti-vaping activists will at least admit that there is no doubt that vaping is significantly less harmful than smoking; as a matter of fact, the harmfulness of vaping is only a tiny fraction of that of smoking.

(b) There is converging evidence from multiple different sources that e-cigarettes are a valuable tool for many smokers to help them quit smoking, often outperforming more traditional smoking cessation aids.

(c) Regular vaping among non-smokers remains relatively rare, and there is no evidence of a “gateway effect” from vaping to smoking, including among young people. Rather, vaping increasingly appears to be the preferred – and far less risky – way of consuming nicotine, for those who would otherwise (that is, in the absence of e-cigarettes) have become smokers.

WHO’s stance on THR is anti-scientific, morally reprehensible, and diametrically opposed to its primary mission:  it costs lives rather than saving them.

---

Fares Mili, MD, CTTS, NCTTP, NCNTT

Pulmonologist- Addictologist
Chairman of the Tunisian Society of Tobacology and Addictive Behaviors ( STTACA)
Tunisia

Worldwide, slightly more than one in ten people (12%) live with a mental health disorder such as depression, bipolar disorder, schizophrenia, an anxiety disorder, a substance use disorder, an alcohol use disorder, a drug use disorder or an eating disorder (Fan et al. 2025). These populations exhibit a disproportionately high prevalence of smoking and very low long-term abstinence rates. Even with optimal treatment involving varenicline combined with behavioral support, cessation success after one year is only around 22% (Anthenelli et al., 2016). Outcomes are even poorer with nicotine replacement therapy, particularly among individuals with psychiatric comorbidities (Evins et al., 2019). Many individuals in these groups, including those on the ADHD spectrum, have dysfunctional nicotinic α7 receptors, which are linked to attention deficits and cognitive disturbances. For these individuals, nicotine use can serve as a form of self-medication to enhance cognitive function (Wallace & Bertrand, 2013). Denying access to nicotine sources that are substantially less harmful than cigarettes, such as smoke-free alternatives, can therefore deepen stigma and health inequities.

This logic extends beyond psychiatric populations: in both high-income countries and low- and middle-income countries (LMICs), marginalised groups are disproportionately affected by smoking. In LMICs, where the MPOWER framework is under-implemented due to economic constraints, weak regulatory environments, corruption, conflict and parallel markets, locally produced smokeless tobacco products are often deeply rooted in culture and widely used. Thus, tobacco harm reduction (THR) offers a pragmatic, science-based complement to traditional cessation strategies. By incorporating safer nicotine products into tobacco control, the WHO and national governments could adopt more flexible approaches that reduce harm for populations least likely to succeed with abstinence-only models, while upholding the ethical principle of reducing disparities in global health.

---

Garrett McGovern, MD, MSc, CISAM, ProfDip

Medical Director – Priority Medical Clinic
GP Specialising in Addiction Medicine &
Clinical Lead HSE Addiction Services CHO8
Dublin, Ireland

The significant harms of smoking are attributable to the inhalation of combustible tobacco. The greater the dependency, the greater the number of cigarettes smoked and the greater the risk of disease burden. The death toll worldwide annually is almost 8 million people. A sensible, rational tobacco harm reduction policy would be to help nudge smokers from a habit that will end their life prematurely towards products that will not only prolong the length of their life but also enhance the quality of that life.  The position adopted by WHO towards safer nicotine products is bizarre, anti-scientific and ideological. These revolutionary products halt the harms caused by smoking, yet the WHO is misinforming the public that SNFs are part of the problem, are probably as harmful as smoking and are causing a youth nicotine addiction epidemic. None of which is supported by peer-reviewed research.

We ask WHO to assess the scientific evidence on the benefits and, indeed, harms of safer nicotine products through the prism of harm reduction, and to examine the remarkable results achieved in Norway, New Zealand, and Sweden (a nation now smoke-free, i.e., < 5% smoking prevalence). These impressive outcomes have been achieved by embracing, not denigrating, safer nicotine products and removing unnecessary legislative barriers to smokers trying to quit.

---

Jose María García Basterrechea, MD

Specialist in Internal Medicine and University Specialist in Drug Dependence.
Former Head of the Drug Dependence Unit at Reina Sofía Hospital in Murcia.
Spain

---

When we are unable to cure, alternatives to improve health are a fundamental part of medicine. Alternatives are decisive in some diseases, such as opioid dependence, and others that are completely integrated into society, as is the case with non-alcoholic beer (manufactured by the alcohol industry).

When the scientific arguments are solid and unquestionable, rejecting low-risk alternatives to tobacco, as the WHO does, can only be understood from partisan, ideological, or fundamentalist political positions, far removed from science and reason, and above all from the primary interest of protecting health. It would be desirable for the WHO’s decisions to be based on debate and scientific evidence, without misinforming the population and ignoring the benefits for the hundreds of thousands of smokers who would benefit from these much less dangerous alternatives to combustible tobacco.

---

Louise Ross

Stop Smoking Lead at Smoke Free Digital
Former service manager, Leicester City Council Stop Smoking Service
United Kingdom

I launched the first-ever vape-friendly stop-smoking service in 2014. I was astonished at the increased success rates in comparison with those who were using traditional stop-smoking aids. Some people who smoke still use licensed medicines, but there must be an alternative available for those who would otherwise continue to smoke. There is no ‘right way’ to stop smoking, and trying to eliminate reduced-risk products will inevitably mean that many will die of smoking-related disease because of anti-vaping dogma.

One of my clients told me only this week: ‘I had smoked for forty years, and I switched to vaping seventeen years ago. My recent chest X-ray showed that my lungs are clear and healthy. I couldn’t have achieved that without having a vape to help me stay off cigarettes.’

There are so many people like him; please recognise their needs and don’t get in the way of them stopping smoking.

---

Mark Tyndall, MD, ScD, FRCPC

Infectious Diseases and Public Health Consultant
Former Director, BC Centre for Disease Control,
Author, Vaping: Behind the Smoke and Fears (2025)
Canada

The concept of harm reduction originated in the world of HIV prevention. Since high-risk exposures were inevitable, it made sense to reduce the risk of transmission. Condoms, methadone maintenance programs, needle and syringe exchanges, and supervised injection sites have prevented millions of HIV infections and improved lives. The effectiveness of these harm reduction interventions is not debatable, yet they remain controversial. Not because they don’t work, but because of the people they help. Mainly people who face stigma, structural violence, punishment, and isolation. The LGBTQ+ community, sex workers, drug users, people with mental illnesses, and communities living in poverty. While advocating for harm reduction, I have heard people say.  Why would you try to reduce the risk of behaviors that we disapprove of? Why help people who are making bad decisions? Aren’t you condoning these behaviors by making them less risky?

Opposition to tobacco harm reduction is similar.  It is not because vaping isn’t far safer than smoking cigarettes or that vaping doesn’t help people quit smoking, but because we don’t approve of the behavior.  Why come up with a safer way to inhale nicotine when we don’t think people should be using nicotine in the first place?  At its core, opposition to vaping and safer nicotine products is based on stigma and ideology. Denying vaping and safer nicotine products to people who smoke cigarettes, is like denying condoms to people at risk of HIV. This is not only bad public health policy but is cruel and unethical.

Fernando Fernández Bueno, MD, MSc

Surgical Oncologist
Head of Hepatobiliary Surgery Section
Hospital Central de la Defensa Gómez Ulla CSVE, Madrid
Spain

Harm Reduction is Not an Option, It is an Ethical Imperative.

As a Surgical Oncologist who deals daily with the devastating consequences of smoking, I firmly oppose the “abstinence-only” stance that the WHO COP11 will likely promote. This position not only ignores the scientific evidence but is profoundly unethical, condemning millions of smokers to an avoidable death.

The clinical and scientific evidence is unequivocal:

1. Risk Differential: The assertion that “there is no apparent difference in risks” between smoked and smoke-free products is scientifically false and irresponsible. Cancer, lung disease, and heart disease are primarily caused by combustion, not nicotine per se. Smoke-free products are orders of magnitude less harmful.
2. Health Goal: Our priority health goal should not be a utopian “nicotine-free society,” but urgently a smoke-free society. Nicotine is addictive, but it is smoke that kills approximately 700,000 EU citizens annually.
3. Harm Reduction (HR): HR is not merely a “marketing strategy”; it is a fundamental public health principle proven successful in areas like HIV and injecting drug use. Countries like the UK and Sweden demonstrate that when HR is used coherently and accessibly, smoking rates drop historically fast.
4. Youth Protection: Total prohibition is not the solution for youth protection. Smart regulations that prioritize adult smokers’ access to less harmful options, while strictly prohibiting sales to minors and misleading advertising, are the ethical route.

The WHO and COP11 delegates have a duty to embrace science and harm reduction instead of condemning adult smokers with prohibitionist policies that, in practice, only benefit the combustible tobacco market.

---

Heino Stöver, PhD

Professor of Social Scientific Addiction Research
Faculty of Health and Social Work
University of Applied Sciences
Frankfurt
Germany

For decades, international tobacco control has been guided by an abstinence paradigm. With this idealistic approach, it has failed. Despite awareness campaigns and smoking bans, millions of people in Europe continue to smoke. The exclusive focus on complete abstinence ignores reality: nicotine dependence is a chronic condition that cannot be overcome by moral appeals alone.

As long as policymakers and the WHO cling to this strategy, the cigarette will remain the dominant and deadliest nicotine product. A more effective way forward lies in harm reduction. Numerous studies show that less risky alternatives such as e-cigarettes, heated tobacco products, and nicotine pouches can support smoking cessation and substantially reduce health risks compared to combustible cigarettes. This evidence should guide policy, not be dismissed for ideological reasons.

Besides that I strongly support the strict enforcement of youth protection. No minor should have access to nicotine products. But for the millions of adult smokers in the EU, there must be accessible, regulated, and less harmful alternatives.

If we truly want to defeat the cigarette, we need less dogma and more scientific pragmatism. The future of tobacco control lies not in prohibition, but in differentiation – between more risk and less risk.

---

Andrzej Sobczak, PhD

Emeritus Professor of Medicine
Medical University of Silesia
Katowice
Poland

As a scientist, I have been studying the negative impact of tobacco smoking on the cardiovascular and antioxidant systems for many years. With the advent of e-cigarettes two decades ago, my team at the Silesian Medical University in Katowice began researching the toxicity of these products. We have published dozens of papers in journals from the Philadelphia list, many in international collaborations, pointing to potential risks. However, the overwhelming majority of research findings showed significantly lower qualitative and quantitative inhalation of toxic substances by e-cigarette users compared to inhalation of tobacco smoke.

Therefore, I absolutely cannot agree with the argument appearing in WHO publications that there is no discernible difference in health risks between smoked and smokeless products, which is likely due to the extensive misinformation surrounding this issue.

My many years of experience as a scientist allow me to state the following: The evidence clearly suggests that vaping carries a lower health risk than smoking tobacco. This impact could be significantly greater if the public health community paid serious attention to vaping’s potential to help adult smokers, and smokers received accurate information about the relative risks of vaping and smoking. Most importantly, policies were designed with the impact on smokers in mind and did not solely address the potential risks to youth.

---

Enrique Terán, MD, PhD

Colegio de Ciencias de la Salud, Universidad San Francisco de Quito USFQ. Quito, Ecuador
Full Member, Ecuadorian Academy of Medicine
Active Member and President, Academy of Sciences of Ecuador

Latin America needs to integrate THR into National Tobacco Control Strategies

Many Latin American countries have successfully implemented the WHO Framework Convention on Tobacco Control (FCTC), which focuses on traditional tobacco control measures such as smoking bans, taxes, and public education (source). However, these measures alone may not be sufficient to address the diverse challenges posed by tobacco consumption in the region. Tobacco harm reduction (THR) should be integrated as a complementary component within FCTC-aligned strategies. Cessation remains the primary goal; for adults who cannot or will not quit, carefully regulated non-combustible options may offer risk-proportionate alternatives alongside clinical support (source, source). Latin American countries urgently need the endorsement of the WHO and PAHO to set a proper regulatory pathway for THR proper adoption rather than the current prohibitions (source).

---

Clive Bates, MA, MSc

Director
Counterfactual
Former Director, Action on Smoking and Health (UK)
Founding partner, Framework Convention Alliance (now GATC)
London
United Kingdom

Everyone in tobacco control should be trying to find the fastest and best way to reduce the total burden of disease and death caused by tobacco and nicotine. There is one, and only one, big, fast and effective way to do that: make nicotine use much safer. Yet the Secretariat, WHO, the loudest Parties, and the narrow subset of NGO activists selected to be observers have thrown themselves into opposing the idea. They are slowing the end of smoking in the foolish hope of ending nicotine use.

Whether we like it or not, nicotine is popular for its moderate calming, stimulating and cognitive effects. It doesn’t matter what we think: people like using it, and that won’t change. It doesn’t matter what we want: nicotine has been used for 12,000 years, and that is not about to stop. The public health challenge is to make the use of this mild psychoactive substance acceptable at the individual and population level.

Tobacco control activists are now striving to achieve a nicotine-free Utopia and the various forms of prohibition needed to bring it about. But this is a pointless quest that is doomed to fail for the same reasons that the war on drugs has failed. They seem to have learned nothing from that. Aiming for a nicotine-free society may seem noble, idealistic and ambitious, but it’s the opposite; it obstructs real-world public health pragmatists from transforming the way this drug is used in society and saving millions of lives. Worse, it is based on dishonest or negligent arguments, amplified to ear-splitting levels by over-confident and unaccountable philanthropists and health bureaucrats.